Pine Valley Camp- Reference Form

Thank you for your willingness to provide honest feedback about the applicant's skills, abilities, and fit for our ministry.

Pine Valley Camp is a Christian organization focused on "rebuilding broken lives through Christ." We serve approximately 700 at-risk children ages 6 to 15 years old over the course of 7 weeks each summer.

Our campers often have broken families and can exhibit behaviors which require significant patience and wisdom from our staff. Applicants applying for Counselor positions need a high degree of spiritual and emotional maturity, as they will spend an entire week responsible for each set of campers in their cabin.

Your reference is especially valuable in determining whether this applicant is prepared for the Pine Valley Camp environment. You can find out more about us by visiting our website at www.pinevalleycamp.org. Thank you so much for your input!

Your Name
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First Name Last Name

Phone Number

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Area Code Phone Number

Applicant's Name
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First Name Last Name

How long have you known him/her?
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0-1 years 2-3 years 4 or more years

What is your relationship to the applicant?
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Employer Church Leader Friend Other option

Please rate the following items on a scale of 1 to 5.

Work ethic
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Social Adaptability
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Initiative
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Physical Stamina
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Common Sense
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Empathy
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Respects Authority
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Flexibility
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Responsibility
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Spiritual Maturity
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Ability to work with at-risk children or teens
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Please answer the following questions to the best of your ability. If you do not know, you may type "unknown."

What words would you use to describe the applicant's personality?
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To the best of your knowledge, what does the applicant's ministry involvement/ work history include?
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Is there any past or present mental or emotional instability in the applicant? If yes, please explain.
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In assembling a leadership team, would you jump at the chance to have the applicant be a member of the team? Please explain why or why not.
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Please comment on the applicant's ability to handle conflict.
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Do you feel the applicant could work under challenging and exhausting circumstances? Please explain.
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Please list any observations (both accolades and concerns) you may have about the applicant's ability to work with children and teens.
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In your observation, is the applicant a leader or a follower?

Would you recommend this applicant for a position at Pine Valley Camp?
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